Improving Diagnosis of Hypertension in Children (IDHC) Abstract: Risk factors for cardiovascular disease, including hypertension, are often established in childhood. Hypertension is becoming more common in children due to increasing rates of obesity. Guidelines for the screening, diagnosis, evaluation, and management of pediatric hypertension are available. Unfortunately, the diagnosis is often missed, due to poor knowledge and the complexity of blood pressure standards. The overall purpose of the proposed research is to develop, implement, and evaluate the impact of a program, Improving Diagnosis of Hypertension in Children (IDHC) in a large network of community-based practices which serve primarily minority children and families. The intervention includes education and/or training for clinicians and parents, as well as clinical decision support within an electronic healh record system which facilitates diagnosis and makes recommendations for follow-up, evaluation, and management. Preliminary data support low rates of diagnosis within the network of practices in which the research will be carried out. The IDHC program will be evaluated through a 15-month cluster randomized trial, in which half of participating practices are randomized to the intervention and half to a control intervention consisting of basic training for nursing staff and physicians only. The principal outcome is the change in the proportion of children whose hypertension is accurately diagnosed between the 15-month period prior to the intervention and the 15-month intervention period in each of the two groups. Secondary outcomes include changes in the rates of screening for hypertension in each 15-month period in each of the two groups and the change in the rates of accurate diagnosis of pre-hypertension in each of the two groups. Should the IDHC intervention be successful in substantially improving diagnosis of hypertension, it can be easily implemented in other settings, thereby having a significant impact upon the health of large numbers of children.